Certified Nurse Midwives

Candace Kugel, Pennsylvania

I work as a Certified Nurse-Midwife at an upstream Community and Migrant Health Center. With every migrant woman I encounter I find myself stretching and reshaping the philosophical idealism of nurse-midwifery. Flexibility and openness are my goals, while protocols and risk criteria become difficult to standardize.

Although I do not feel we are particularly well-prepared for the task of caring for migrant women, I do feel that CNM's are well-suited for this work. A migrant woman has never challenged my credentials or asked to be seen by a "real doctor." Most are visibly relieved to learn that they will be cared for by a woman. When I have faced discussing abortion with a Haitian woman through and interpreter; or providing the first pelvic examination for a Mexican woman who has already had six children; or developing a management plan for a woman who is post-term had a previous cesarean section, and is living in a car with her small child and unemployed husband, I know that I am as capable as any other provider to stumble through these interactions.

Since farmworkers come to our area for only four months of the year, it is rare that I care for a migrant woman through her entire pregnancy. I may diagnose her pregnancy, I may see her for three or four prenatal visits (augmenting my data base with records she has brought from another location), or I may meet her only once before she goes into labor and delivers here baby. Migrant families have at times chosen to stay in our area until the baby is born, but usually leave before the baby's two-week check up. I struggle with the desire to make a difference in a short period of time and with the disappointment of not being able to follow-through.

It is difficult to really prepare a nurse-midwife new to migrant health. What you can certainly expect are unbelievable clinical challenges and cultural adventures.